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Vision loss after accidental methanol intoxication: a case report.

Moschos MM, Gouliopoulos NS, Rouvas A, Ladas I - BMC Res Notes (2013)

Bottom Line: Visual acuity demonstrated no light perception bilaterally, pupils were semi-dilated and unreactive to light, while the retina was normal in both eyes.The neurological examination and the computed tomography scans did not reveal any abnormalities.The laboratory evaluation was normal and the urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, salicylates, barbiturates, and phencyclidine.

View Article: PubMed Central - HTML - PubMed

Affiliation: 1st Department of Ophthalmology, University of Athens Medical School, 'G, Genimmatas' General Hospital Athens, 154 Mesogion Avenue, Holargos 11527, Athens, Greece. moschosmarilita@yahoo.fr.

ABSTRACT

Background: Methanol intoxication is a dangerous situation because it often results in permanent problems such as visual deterioration, metabolic disturbances, neurological dysfunction, and even death. We present, to the best of our knowledge, the first case of irreversible bilateral blindness due to methanol intoxication caused by accidental ingestion of rubbing liquid.

Case presentation: A 49-year-old Greek man developed bilateral irreversible blindness after accidental methanol intoxication. He underwent complete ophthalmological examination, including electroretinogram, visual evoked potentials, multifocal-visual evoked potentials, and optical coherence tomography scan of the optic nerve. Complete laboratory evaluation, urine drug testing, neurological examination, and computed tomography scans were also performed. Visual acuity demonstrated no light perception bilaterally, pupils were semi-dilated and unreactive to light, while the retina was normal in both eyes. Electroretinogram was normal, while visual evoked potentials, multifocal-visual evoked potentials recording, and optical coherence tomography scanning of both optic nerve heads were pathological in both eyes. The neurological examination and the computed tomography scans did not reveal any abnormalities. The laboratory evaluation was normal and the urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, salicylates, barbiturates, and phencyclidine.

Conclusion: This is the first case report of methanol intoxication which documents both anatomical and functional abnormalities by means of optical coherence tomography and electrophysiological tests correspondingly. The ocular findings and the reported electrophysiological changes support the hypothesis that methanol affects photoreceptors, Müller cells, and the retrolaminar portion of the optic nerve.

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Visual evoked potential recording; Visual evoked potential recording is extremely decreased bilaterally.
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Figure 2: Visual evoked potential recording; Visual evoked potential recording is extremely decreased bilaterally.

Mentions: A 49-year-old healthy Greek man without any prior significant medical history, working as a cook on a merchant ship, drank accidentally a glass of 70% methanol rubbing solution, while he was on board. One day later he complained for blurred vision and painful eye movement in both eyes. The second day he woke up blind. He remained on board since the ship was heading to Australia and so treatment was impossible. When the ship reached Australia, he was hospitalized for a week. On arrival his vital signs were within normal limits and his examination tests revealed normal muscle tone. His initial laboratory evaluation included a complete blood count, electrolytes, blood urea nitrogen, creatinine, and serum glucose. All test results were within the normal range for the patient’s age. A urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, phencyclidine, salicylates, and barbiturates. The blood methyl alcohol and formic acid values could not be determined. No treatment was given due to patient’s late arrival. He then was transferred to the University Eye Clinic of Athens. At presentation he underwent a complete ophthalmological examination. Visual acuity was no light perception in both eyes. The pupils were semi-dilated and unreactive to light. Fundus examination revealed an unremarkable retina in both eyes with the exception of pronounced pale, atrophic optic discs with “pseudoglaucomatous” thinning of the neuroretinal rim area. Electroretinogram (ERG) was normal in both eyes (Figure 1). Visual evoked potentials (VEPs) were nearly extinguished (Figure 2). Multifocal-visual evoked potential (mf-VEP) recording was also pathological in area 0 (right eye: 169 nV/deg2 and left eye: 186 nV/deg2) (Figure 3). Optical coherence tomography (OCT) of the optic nerve head demonstrated abnormally low values of the retinal nerve fiber layer (RNFL) thickness equal to 128 μm in the superior, 39 in the nasal, 108 in the inferior, and 72 in the temporal quadrant of the right eye (OD), and 134, 99, 92, and 58 correspondingly of the left eye (OS) (Figure 4).


Vision loss after accidental methanol intoxication: a case report.

Moschos MM, Gouliopoulos NS, Rouvas A, Ladas I - BMC Res Notes (2013)

Visual evoked potential recording; Visual evoked potential recording is extremely decreased bilaterally.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222078&req=5

Figure 2: Visual evoked potential recording; Visual evoked potential recording is extremely decreased bilaterally.
Mentions: A 49-year-old healthy Greek man without any prior significant medical history, working as a cook on a merchant ship, drank accidentally a glass of 70% methanol rubbing solution, while he was on board. One day later he complained for blurred vision and painful eye movement in both eyes. The second day he woke up blind. He remained on board since the ship was heading to Australia and so treatment was impossible. When the ship reached Australia, he was hospitalized for a week. On arrival his vital signs were within normal limits and his examination tests revealed normal muscle tone. His initial laboratory evaluation included a complete blood count, electrolytes, blood urea nitrogen, creatinine, and serum glucose. All test results were within the normal range for the patient’s age. A urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, phencyclidine, salicylates, and barbiturates. The blood methyl alcohol and formic acid values could not be determined. No treatment was given due to patient’s late arrival. He then was transferred to the University Eye Clinic of Athens. At presentation he underwent a complete ophthalmological examination. Visual acuity was no light perception in both eyes. The pupils were semi-dilated and unreactive to light. Fundus examination revealed an unremarkable retina in both eyes with the exception of pronounced pale, atrophic optic discs with “pseudoglaucomatous” thinning of the neuroretinal rim area. Electroretinogram (ERG) was normal in both eyes (Figure 1). Visual evoked potentials (VEPs) were nearly extinguished (Figure 2). Multifocal-visual evoked potential (mf-VEP) recording was also pathological in area 0 (right eye: 169 nV/deg2 and left eye: 186 nV/deg2) (Figure 3). Optical coherence tomography (OCT) of the optic nerve head demonstrated abnormally low values of the retinal nerve fiber layer (RNFL) thickness equal to 128 μm in the superior, 39 in the nasal, 108 in the inferior, and 72 in the temporal quadrant of the right eye (OD), and 134, 99, 92, and 58 correspondingly of the left eye (OS) (Figure 4).

Bottom Line: Visual acuity demonstrated no light perception bilaterally, pupils were semi-dilated and unreactive to light, while the retina was normal in both eyes.The neurological examination and the computed tomography scans did not reveal any abnormalities.The laboratory evaluation was normal and the urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, salicylates, barbiturates, and phencyclidine.

View Article: PubMed Central - HTML - PubMed

Affiliation: 1st Department of Ophthalmology, University of Athens Medical School, 'G, Genimmatas' General Hospital Athens, 154 Mesogion Avenue, Holargos 11527, Athens, Greece. moschosmarilita@yahoo.fr.

ABSTRACT

Background: Methanol intoxication is a dangerous situation because it often results in permanent problems such as visual deterioration, metabolic disturbances, neurological dysfunction, and even death. We present, to the best of our knowledge, the first case of irreversible bilateral blindness due to methanol intoxication caused by accidental ingestion of rubbing liquid.

Case presentation: A 49-year-old Greek man developed bilateral irreversible blindness after accidental methanol intoxication. He underwent complete ophthalmological examination, including electroretinogram, visual evoked potentials, multifocal-visual evoked potentials, and optical coherence tomography scan of the optic nerve. Complete laboratory evaluation, urine drug testing, neurological examination, and computed tomography scans were also performed. Visual acuity demonstrated no light perception bilaterally, pupils were semi-dilated and unreactive to light, while the retina was normal in both eyes. Electroretinogram was normal, while visual evoked potentials, multifocal-visual evoked potentials recording, and optical coherence tomography scanning of both optic nerve heads were pathological in both eyes. The neurological examination and the computed tomography scans did not reveal any abnormalities. The laboratory evaluation was normal and the urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, salicylates, barbiturates, and phencyclidine.

Conclusion: This is the first case report of methanol intoxication which documents both anatomical and functional abnormalities by means of optical coherence tomography and electrophysiological tests correspondingly. The ocular findings and the reported electrophysiological changes support the hypothesis that methanol affects photoreceptors, Müller cells, and the retrolaminar portion of the optic nerve.

Show MeSH
Related in: MedlinePlus